Psychosocial reintegration - an overambitious goal in schizophrenia patients?

Abstract

Nowadays treatment and rehabilitation of schizophrenia patients demonstrate promising results, especially for symptom remission. E.g. up to 80% of first-episode patients show symptom remission at 1 year after starting pharmacological treatment. But despite initial symptom reduction there is still poor functional recovery following a first psychotic episode: about the same percentage fail to demonstrate former social and occupational functioning or quality of life within 6 months after starting pharmacological treatment despite symptom recovery. These functional impairments are present up to 5 years after illness onset even when optimal pharmacological treatment is provided. Different studies point out that deficits in neurocognition (e.g. attention, memory, executive functioning) and social cognition (e.g. emotion and social perception, insight, social schema, attributional style) might be a main source for explaining this poor functional outcome.Against this background our research group in Bern has developed therapy programs focussing especially on neuro- and social cognition. Integrated Psychological Therapy (IPT) was tested in 32 controlled studies in different countries with a total sample of 1420 patients. A further development of IPT is the Integrated Neurocognitive Therapy (INT) that is evaluated in a still ongoing multi-centre study. Data of a metanalysis of IPT and first results with 28 patients of the INT study indicate beneficial improvements in neuro- and social cognition, self-efficacy and self-perceived quality of life. These results confirm the importance of psychological therapies in combination with pharmacological treatment to optimize functional outcome and recovery.